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Children with Special Needs

Types of Related Trusts

Staff Writers 

A trust can be established to insure that funds are available for a disabled child’s lifestyle. If funds are left directly to a physician’s child at the age of majority, Medicaid is lost until their funds are spent down. The type of trust chosen is therefore critical.

Medicaid, Payback or OBRA 93 Trust:  

First authorized by the Omnibus Budget Resolution Act of 1993, allows the trust for pay for non-essentials.  The specific language must be written in to the exact letter. Upon the death of the child the Medicaid bill is repaid from the funds remaining in the trust, and thus the Medicaid and SSI benefits continue to be available to the child during her lifetime.  The payback trust is more advantageous when established at an early age.  The funds in the trust can then be stretched out to last over an extended period, hopefully the child’s lifetime.  Here are two examples where such a trust is an effective vehicle.   

In the first case, a payback trust is set up for a 21-year-old with $100,000.  During his lifetime the Trust spends $92,000.  The Medicaid bill is $75,000.  Medicaid receives the remaining $8,000 and the bill is considered paid in full. 

In the second case, a payback trust of $350,000 is set up for a 35-year-old.  Upon the child’s death, the trust has assets of $225,000 and the Medicaid costs due are $75,000.  The trust then meets its Medicaid obligation and the remaining $150,000 is available for other beneficiaries.   

Other effective trust vehicles include a community trust, master trust and special needs trust, each with its own set of rules. 

Community Trust:

This trust is managed by a community foundation of volunteer trustees so the issue of dealing with trustee death is erased. This trust vehicle greatly expands the window of opportunity to those who may not have the time, expertise or funds to establish a private trust, to receive the benefits of a trust.  

Master Trust: 

May be established by a community or by an organization and is administered along the lines of a Community trust.

Special Needs Trust:  

This trust may maintain Medicaid and Social Security benefits, without having the payback clause. Unfortunately, this trust is sometimes challenged as it entails more risk than a payback trust and must be considered carefully before selection.

For example, a situation where this may be put in place is when gifting by family members is used to support the specialized schooling of a disabled child.

The Crummey Trust: 

Trust named after the D. Clifford Crummey family who first set it up to deny the annual gift tax exclusion. A Crummey Trust does not give the child any right to income but does give the right to withdraw the amount of each gift up to 30 days after it is made. Since the withdrawal right begins immediately after the gift is made, it is considered a present interest. If the child does not withdraw the gift within the 30 days, the withdrawal right lapses and the money remains in the trust until the child attains a designated distribution age. 

Of course, parents must still convince the child not to withdraw. However, if the child decides to withdraw, s/he can only access the amount of the most recent gift; not the entire trust. Thereafter, parents can eliminate all future withdrawal opportunities by not making any more gifts. The property in the trust remains intact and grows until distributed.  This private trust option and its language must be specific to avoid disqualification. 

The Charitable Remainder Trust:

 

This is an irrevocable trust with the beneficiary enjoying the trust funds and the charity receiving the remainder upon death.  The tax exempt status of a CRT may make the funds in the trust last longer.  If the charity is a nonprofit organization involved in the caring of special needs children, the physician’s family can show gratitude with a CRT.  

The Irrevocable Life Insurance Trust: 

An ILIT may be used in tandem with the various trust vehicles to assure continued funding for the child after one or both parents have died. 

Which of the above trust types have you used and what were the results?

Funeral Expenses

The Perilous Last Economic Journey

By Staff Writers

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As a physician or other medical professional, perhaps you have not considered the immediate cost of death related activities; in other words – your funeral and its follow-up last expenses. 

When one considers the cost of a funeral, with casket, embalming, burial and other itemized costs and service related expenses, the average price tag is about $8,500 and of course, purchasing the burial plot is extra. The cost of the average cremation is about $850.   

Further information relating to burial finances, can be obtained from Consumer Caskets USA at 800-611-8778, the Choice in Dying at 88-989-9455, and the Funeral and Memorial Society of America at 802-482-3437. All have internet web sites. 

Remember, life is a perilous journey.

Assessment

Have you planned for funeral follow-up and/or last living expenses?

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401-k and 403-b Retirement Plans

The Time to Change Allocations

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By Clifton McIntire; CIMA, CFP®

By Lisa McIntire; CIMA, CFP®fp-book1 

401k and 403b plans offer great opportunity to change asset allocations.   

For example, Karen Markland, a Certified Registered Nurse Anesthetist at Carolina’s Medical Center, found it was relatively easy to shift from bonds to stocks some years ago. No taxes or commissions were involved. A simple phone call moved her allocation from 40 percent bonds, 50 percent stocks and 10 percent international to 20 percent bonds, 70 percent stocks and 10 percent international after a recent stock market decline. 

One point of caution when using 401k or 403-b plans for asset allocation is required. Quite often the trustees of 401k plans will decide on a single group of mutual funds for the participants. Not all funds in the group are worthy of your money.

Jean Surber, a Certified Registered Nurse Anesthetist at Presbyterian Hospital, did not have a good international option and so had to limit her allocation in that 401k plan to stocks, bonds and cash. She used her Individual Retirement Account (IRA) at a brokerage firm for international investing.

Employed healthcare professionals should “max out” on their 401k/403b plans. You should put all that you are allowed into your 401k/403b plan, unless the selection of managers is so bad that even with the tremendous tax break and “dollar cost averaging” of monthly contributions, the envisioned end results would be small.  

For example, the simple compounding of $10,000 at age 30 investing $416 per month and experiencing a 10 percent annual rate of return would provide $1,905,788 at age 65. 

Wake-Up Call 

The Federal Government annually mails a detailed explanation of social security benefits to its workers.  This is an attempt to remind people that social security fulfills only part of their retirement income needs. To many, this will be a wake up call. The status of 401k or 403b plans is normally sent to participants’ quarterly. This is an excellent time to do some asset allocation and review manager performance.  Since most 401ks and 403bs use mutual funds and/or ETFs, and offer daily valuations by telephone, you don’t have to wait for the quarterly report, which is often received 60 days after the end of the quarter. When changes are made in the allocation of existing positions, the percentage allocation of future contributions should be made as well. 

For example, when Karen Markland repositioned her 401k portfolio, she also changed her future contribution percentages. 

Information Sources 

Morningstar, a Chicago based company that analyzes and computes statistics on most of the mutual funds produces a monthly report that you can review at the library, or online at home.Most banks and brokerage firms subscribe to this service. They can send you an up to date single page analysis of each of your funds; or an internet syndication feed. This is good material, well researched, but it is historical data.“Past performance is no assurance of future results.” 

The Morningstar system rates funds from 1 star (worst) to 5 stars (best).  This is sometimes referred to as the Sesame Street method of selecting mutual funds.  If you can count to 5, you can pick the best fund. Using this report alone is like driving on an Interstate highway at 80 miles per hour using only the rear view mirror (that can be fatal). 

Why; it’s because fund portfolio managers’ change. Good managers are hired away by their competitors; bad managers are fired. Managers themselves are not always consistent in maintaining their style or in their performance. Morningstar and the Internet is a good place to start because you can review a lot of information at a single setting. You can see historical returns, sector weightings, manager tenure, investment style, costs (except trading commission expense) and statistics concerning risk. However, Morningstar’s independence has been questioned of late. Nevertheless, it is from these and many similar sources that you may learn of the performance you can reasonably expect. 

Few physician managers, but many financial advisors are well versed in a variety of mutual funds. Representatives of the funds call on them frequently.  Many brokerage firms perform independent due diligence research. Mutual funds are a large part of the Financial Services Industry and you can expect the availability of extensive information. 

Stay the Course 

Most 401k and 403b plans should be invested for growth of capital. You are generally talking about long-term investment objectives.You should be very reluctant to withdraw funds from this tax-sheltered environment.  Unfortunately far too often, the participant becomes discouraged, (usually in a down market cycle) and moves the money out of stocks and into a money market fund at the wrong time. 

It is not unusual to see doctor participants assume a very defensive posture a year or so before retirement. This is shortsighted. The investments are meant to provide income and growth of capital for many years, not just until retirement. Upon retirement the funds will be rolled out directly into an IRA and invested with almost the same asset allocation. 

Conclusion

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Terminal Illness and Anatomic Gifts

Placing your Affairs in Order

Staff Writers

 

As a doctor, you face the realities of death on a daily basis. 

And so, if you are yourself diagnosed with a terminal illness the following may not be helpful to you, but might be of help your survivors:

 

 

 

· Increase liquidity to cover the costs of pre- and post- death expenses.

· Contract your local social security office to determine eligibility for  disability and death benefits.

· Determine the contents, and those you wish to have access to your safety deposit box(es).

· Since some states do not have death taxes, consider changing your domicile.

· Preserve your testimony to any outstanding claims or litigation regarding personal or professional affairs, through a formal legal deposition or other means. 

 

 

Also, as a lay or medical professional, consider organ donation since the supply of donated organs is dwarfed by the demand for them.  The Coalition on Donation is on a campaign to raise awareness of this need.  The decision to be an organ donation is personal and some healthcare professionals have philosophical or religious beliefs that prohibit this option. 

However, if you decide to be an organ donor, documentation and communication are the critical steps to insuring your wishes are carried out.

First, contact your local motor vehicle department and inform your family and loved ones. Then, inform your own personal physician in writing, and wear a donor identification bracelet – or something similar – that fits in your wallet or purse, so your wishes are known.

Has the above information helped you turn a potential financial disaster into a manageable pitfall?

Financial Windfalls

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Successfully Handling the Brass Ring

[By Staff Writers]

If you are a physician or healthcare executive who is fortunate enough to win the lottery, or receive a large inheritance, the following simple rules will help maintain your emotional stability, as well as financial health.

###

Dollars

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· Deposit cash into a money market account in your name or into a joint account with your spouse, and limit access. If a doctor is the executor of an estate, be aware that significant tax benefits may result by freezing the estate for six months and using the alternate valuation method of size determination. Similarly, if a windfall is in the form of securities, make sure they are titled correctly.  Limit those to whom you tell about your luck.

· Hire a Registered Investment Advisor (RIA), Certified Medical Planner™, CPA or other financial fiduciary to lead your team of lawyers and insurance agents. Get tax advice immediately.

· Do not quit your job, sell your practice, or initially disrupt your life materially. 

· Maintain your normal routine.

· Limit your new expenditures and consider your lifestyle options.

· Redefine your financial plans, and continue to save and invest.

· Pay down your debt and recall that non-deductible debt costs the stated APR, while deductible debt costs less if you itemize.

· Review your insurance policies, will, estate plan or trusts.

· Avoid friends or relatives who petition you for money.

· Consider charitable interests and gifting strategies carefully.

· Exercise, stay healthy and enjoy your windfall.

Assessment

Now, if you won the lottery; your experiences – no matter how major or minor – are appreciated.

Conclusion

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Alternative Financial Clout

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On the Gay Financial Network [GFN]

[By Staff Writers]

A useful resource to supplement the financial knowledge of gay medical or lay professionals is the Gay Financial Network www.gfn.com

Gays and lesbians control more than $800 billion, according to the network, and the nations’ most gay friendly companies include IBM, AT&T, Bank of America Corp., Google, Yahoo, Mobil Corp., and Hewlett-Packard Co., according to the network.

By its own estimates, there are more than 25 million homosexuals in the USA, and more than 10 million are on-line. About 75 percent of the network’s members are men, 25 percent women, and the majority aged 30-50. Sixty percent visit the site daily, and about 15 percent earn more than $100,000. 

Assessment

And, the fact that this information is geared toward alternative lifestyles should not let it be an impediment toward using the information.  

For example, did you know that the same penalties associated with pension plans and estate tax laws, also impact unmarried straight couples in the same manner as a gay couple?

*** GFN

***

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Alternative Lifestyles

Understanding Exactly What’s at Risk

Staff Writers

 

A function of Social Security is to be an old age pension plan supplement.  It also offers survivor benefits for a physician’s spouse and children.  The benefit is not paid to a live-in companion, however. 

Social Security also offers a disability payment for those unable to work.  This benefit will be available to those who qualify, but calculated at a single individual’s rate for those unmarried. 

One area where a bonus may be earned is the old age pension program. This will be paid to every qualifying individual.

In other words, if both you and your significant other qualify for maximum benefits, these will be received for your lifetime.  You will not be subject to a reduced survivor benefit.

Medicare pays health insurance benefits based upon the individual.  These benefits will be affected by a non-traditional relationship.  Yet, the family pieces of this puzzle are missing under current Medicaid guidelines.

Marriage Benefits 

The federal and state governments, as well as corporate America, confer many benefits, protections and obligations to married couples, among them: 

  • Assumption of spouse pension
  • Automatic housing lease transfer
  • Automatic inheritance
  • Bereavement leave
  • Burial determination
  • Child custody
  • Confidentiality of conversations
  • Crime victim’s recovery benefits
  • Divorce and domestic violence protection
  • Exemption on property tax upon partner’s death
  • Family leave to care for sick partner
  • Immunity from testimony against spouse
  • Insurance benefits and breaks
  • Joint adoption, foster care and custody
  • Joint bankruptcy
  • Joint parenting to care for partner
  • Medical decisions on behalf of partner
  • Property rights
  • Reduced rate membership
  • Social security benefits
  • Tax advantages
  • Visitation of partner’s children
  • Visitation of partner in hospital or prison
  • Wrongful death benefits

The Estate Tax Penalty 

Estate law is unforgiving and its penalties are truly gender and relationship blind.

As an example, the powerful first tool in a well-written estate plan, the unlimited marital deduction, is not possible.   This is a fact which must be recognized and dealt with in a proactive manner. 

Do not be misled by your local or state law that may recognize a relationship involving a significant other. The federal estate tax code simply does not exist for such a relationship. 

Have you been affected by any of the above?

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